Correlation between phenotypic characteristics of mononuclear cells isolated from human periapical lesions and their in vitro production of Th1 and Th2 cytokines.

UNLABELLED: The development and progression of periapical dental lesions, mediated by the specific immune response, are poorly understood. In these processes, an interplay of different proinflammatory and immunoregulatory cytokines is of crucial importance. OBJECTIVES: To examine the activation of T helper 1 (Th1) and Th2 immune responses in 25 human periapical lesions based on the ex vivo production of interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) by mononuclear cells (PL-MNC). METHODS: The levels of IFN-gamma and IL-4 in culture supernatants of PL-MNC, determined by ELISA, were correlated with concentrations of these cytokines in cultures of control MNC from peripheral blood (PB-MNC), cellular composition of inflammatory cells and phenotypic characteristics of PL-MNC. RESULTS: We detected high levels of IFN-gamma in all samples, after cell stimulation with phorbol myristate acetate and Ca(2+) ionophore, that were not statistically different from the levels of IFN-gamma in PB-MNC cultures. IL-4 was detected in 76% samples, but its concentrations were much lower than in PB-MNC samples. The levels of IFN-gamma were higher in cultures of PL-MNC isolated from periapical lesions with predominance of T cells (T-type lesions) and correlated positively with the proportion of antigen-presenting cells (macrophages and dendritic cells), CD4(+) T cells and IgG2(+) B cells/plasma cells. The levels of IL-4 correlated negatively with the proportion of macrophages, but positively with the number of mast cells and IgG4(+) cells. IL-18Ralpha, a stable marker of Th1 cells, was detected on a relatively small proportion of CD3(+) T cells and its expression correlated with the levels of IFN-gamma. However, the expression of ST2L, a stable Th2 cell marker, was not detected. The levels of Th1 and Th2 cytokines did not correlate with clinical characteristics of the lesions, defined by the presence of symptoms. CONCLUSION: Cumulatively, our results suggest the predominance of Th1 immune response in periapical lesions.

Salivary enzymes and periodontal disease.

BACKGROUND: Host responses to periodontal disease include the production of different enzymes that are released by stromal, epithelial or inflammatory cells. There are important enzymes associated with cell injury and cell death like: aspartate and alanine aminotransferase (AST, ALT), lactate dehydrogenase (LDH), creatine kinase (CK), alkaline and acidic phosphatase (ALP, ACP), gama glutamyl transferase (GGT). Changes in enzymatic activity reflect metabolic changes in the gingiva and periodontium in inflammation. DESIGN OF STUDY: In this paper we have examined the activity of CK, LDH, AST, ALT, GGT, ALP and ACP in saliva from patients with periodontal disease before and after periodontal treatment (experimental group, 30 samples) and in saliva from healthy patients (control group--20 samples). Periodontal disease was determined based on clinical parameters (gingival index (GI), bleeding on probing (BOP), probing depth (PD)). Patients with periodontal disease were under conventional periodontal treatment. RESULTS: Obtained results were shown statistically significant increases of activity of CK, LDH, AST, ALT, GGT, ALP, ACP in saliva from patients with periodontal disease in relation to control group. There is positive correlation between the activity of examined salivary enzymes and value of the gingival index. After conventional periodontal therapy the activity of all salivary enzymes was significantly decreased. CONCLUSIONS: Based on these results, it can be assume that activity of these enzymes in saliva, as biochemical markers for periodontal tissue damage, may be useful in diagnosis, prognosis and evaluation of therapy effects in periodontal disease.

[Nasopalatine duct cyst].

BACKGROUND: Nasopalatine duct cyst is a developmental, nonodontogenic cyst of jaw. CASE REPORT: We presented a 46-year-old male with nasopalatine duct cyst. The clinical examination revealed fluctuant swellings of the anterior palate, without pain, 4-5 cm in diametar. Both radiographs showed the presence of an ovoid radiolucency located in the midline of the maxilla between the roots of central maxillary incisor teeth with peripheral sclerosis, 25 x 35 cm in diametar. Surgical treatment was performed under local anaesthesia (Articainchloridum 4% - 3M ESPE) using a palatine approach. Postoperatively, no paresthesia of the anterior palate in inervation area of nasopalatine nerve was registrated. Pathohistologic findings proved both clinical and radiological diagnosis. CONCLUSION: Nasopalatine duct cyst is a rare lesion which slowly develops. The diagnosis is mainly based on radiography, tooth vitality testing and histologic findings. After a correctly applied clinical diagnosis procedure and surgicel treatment, recurrence is rare.

Interleukin-17 plays a role in exacerbation of inflammation within chronic periapical lesions.

Interleukin (IL)-17 plays an important role in inflammation and certain autoimmune diseases. However, its role in the pathogenesis of chronic dental periapical lesions has not been studied. Periapical lesion mononuclear cells (PL-MNC) were isolated from inflammatory cells and phenotypically analyzed by immunocytochemistry. The cells were cultured in vitro and IL-17 and IL-8 were measured in the culture supernatants. Controls were peripheral blood (PB) MNC. The level of IL-17 and the proportion of neutrophils were significantly higher in symptomatic lesions. In addition, the production of IL-17 was higher in culture supernatants of PL-MNC isolated from lesions with a predominance of T cells, and the IL-17 concentration correlated with the proportion of CD3+ and CD4+ cells. There was a positive correlation between the levels of IL-17 and IL-8 in the group of symptomatic lesions. The relationship between these cytokines was additionally confirmed on the basis of augmented production of IL-8 by both PL-MNC and PB-MNC treated with IL-17. Our results suggest that IL-17, by stimulating the production of IL-8, may play a role in exacerbating inflammation within chronic periapical lesions.

[Examination of cardiovascular function variables in tooth extraction under local anesthesia].

BACKGROUND/AIM: Local anesthesia is the one of the most used procedures in surgical practice. It is used for toot extraction to produce analgesic and anesthetic effects. However, there is a question if it is equally safe to apply a local anesthetic combined with a vasoconstrictor (adrenaline) in healthy persons, and in the patients with a certain cardiovasccular system disease. The aim of this stady was to determine whether there were differences in cardiovascular variables during tooth extraction in healthy persons, and in cardiovascular patients when an anesthetic was applyted with adrenaline, or without it. METHODS: The examinees were divided into the group with cardiovascular diseases (CV, n=57) of H and III type, according to the American Society of Anesthesiologists (ASA) qualification, and healthy persons (H, n=55). Both groups were randomly divided into two subgroups: CVa and Ha--where the anesthetic solution had the vasoconstrictor (3% lidocaine, and 1: 100,000 adrenaline); CVb and Hb--where the anesthetic solution was without the vasoconstrictor (3% lidocaine). During the preparation for tooth extraction, the application of anesthetics, extraction and relaxation puls (fc), systolic (TAs) and diastolic arterial blood pressure (TAd) and ECG were registered. RESULTS: The values of fc did not significantly differ among the groups in any measured term. The values of systolic and diastolic blood pressure in the groups CVa and CVb were significantly higher in all the terms of measuring (p < 0.05) from the values in the groups Ha and Hb. A significant increase of TAs was registered only in the phase of tooth extraction in the CVa and CVb group (< 0.05). The values of TAd did not significantly differ between the groups in all the measured terms. Extrasystolic beats were registered in 11 patients of the CV group and in 7 patients of the H group in the phase of anesthetic application or tooth extraction. CONCLUSION: This research shoved that tooth extraction under local anesthesia did not cause complications in cardiovascular patients who were in II or III ASA qualification group, regardless the presence of a vasoconstrictor in the local anesthetic solution.

[Unerupted lower third molar as a cause of acute infection in soldiers].

BACKGROUND/AIM: To record the frequency of infections as complications accompanying the unerupted lower third molars and to determine if there was a significant level of the relationship between the frequency and the severity of infections and the age of patients. METHODS: This study included 100 soldiers of the Army of Serbia & Montenegro, with the unerupted third molars, of male sex, 18 to 25 years old, who were receiving clinical treatment. RESULTS: In 73% of the patients the infection was caused with the unerupted lower third molars. The highest frequency of infection was observed in the group of 20-23 years of age (75.3%). Mild infection occurred in 49 (67.1%) of the patients. CONCLUSION: The frequency of infection was significantly higher in the older patients. Because of the high frequency of the infection recorded, the unerupted lower third molars should be surgically removed before the age of 20.

[Use of thrombin powder after tooth extraction in patients receiving anticoagulant therapy]. / Primena trombinskog praha posle ekstrakcije zuba kod bolesnika koji primaju antikoagulantnu terapiju.

Patients with extreme hypocoagulation, which occurs either as an effect of some diseases with coagulation deficiency or because of the anticoagulant therapy (ACT), are a risk group for oral surgery. In the last decades decision to change or interrupt ACT before and after the procedure was abandoned and more often local heamostasis was being achieved by combining chemical and biological substances. The success of the surgical hemostasis and thrombin powder combination was tested on the group of 20 patients with ACT. The results were satisfactory despite thrombin powder solubility in the moist oral environment.

Enzimas salivales y enfermedad periodontal / Salivary enzymes and periodontal disease

Objetivos: Las enfermedades que producen daño tisular producen la liberación de diferentes enzimas relacionadas con la muerte y destrucción celular, como son la aspartato y alanino aminotransferasa (AST, ALT), lactato dehidrogenasa (LDH), creatinin kinasa (CK), alcalina y ácida (ALP, ACP) y gamma glutamil transferasa (GGT). Al tratarse la enfermedadperiodontal (EP) de un proceso inflamatorio con afectación de la encía y periodonto, parece lógico pensar que la actividad enzimática debe reflejar los cambios metabólicos secundarios a esta reacción inflamatoria.Diseño del estudio: En este artículo examinamos la actividad de CK, LDH, AST, ALT, GGT, ALP y ACP en la saliva de pacientes con EP, antes y después del tratamiento periodontal (grupo experimental–30 muestras) así como en la saliva de pacientes sin enfermedad periodontal (grupo control–20 muestras). La EP se diagnosticó en base a parámetros clínicos(índice gingival–GI, sangrado al sondaje-BOP y profundidad al sondaje-PD). Todos los pacientes con enfermedad periodontal recibieron tratamiento convencional de la misma. Se registró la actividad enzimática en todos los pacientes y se cuantificó por espectrofotometríaResultados: Se observó un aumento estadísticamente significativo en la actividad de CK, LDH, AST, ALT; GGT, ALP y ACP en la saliva de los pacientes con enfermedad periodontal en relación a los resultados obtenidos en el grupo control. Se detectó una correlación positiva entre la actividad de las enzimas salivales examinadas y el valor del GI. Después del tratamiento periodontal convencional la actividad de estas enzimas salivales disminuyó significativamente.Conclusiones: Basándonos en estos resultados. Podemos concluir que la actividad de estas enzimas puede ser útil en el diagnóstico y evaluación del tratamiento de la EP

Background: Host responses to periodontal disease include the production of different enzymes that are released by stromal, epithelial or inflammatory cells. There are important enzymes associated with cell injury and cell death like: aspartate and alanine aminotransferase (AST, ALT), lactate dehydrogenase (LDH), creatine cinase (CK), alkaline and acidic phosphatase (ALP, ACP), gama glutamil transferase (GGT). Changes in enzymatic activity reflect metabolic changes in the gingiva and periodontium in inflammation.Design of Study: In this paper we have examined the activity of CK, LDH, AST, ALT, GGT, ALP and ACP in saliva from patients with periodontal disease before and after periodontal treatment (experimental group – 30 samples) and in saliva from healthy patients (control group – 20 samples). Periodontal disease was determined based on clinical parameters (gingival index (GI), bleeding on probing (BOP), probing depth (PD)). Patients with periodontal disease were under conventional periodontal treatment.Results: Obtained results were shown statistically significant increases of activity of CK, LDH, AST, ALT, GGT, ALP, ACP in saliva from patients with periodontal disease in relation to control group. There is positive correlation between the activity of examined salivary enzymes and value of the gingival index. After conventional periodontal therapy the activity of all salivary enzymes was significantly decreased.Conclusions: Based on these results, it can be assume that activity of these enzymes in saliva, as biochemical markers for periodontaltissue damage, may be useful in diagnosis, prognosis and evaluation of therapy effects in periodontal disease